The high incidence of coronary heart disease in Finland and its probable causes

Abstract

The mortality from coronary heart disease (CHD) in Finland is remarkably high; according to the vital statistics released by the World Health Organization it has for many years been the highest in the world. This, however, concerns only the male sex; in the females the mortality figures, though also relatively high, do not very markedly differ from those of many other populations. It is also noteworthy that the CHD mortality in the eastern provinces of Finland is higher than in the western provinces.

In the etiology of CHD a number of risk factors have been identified. The major ones are: high serum cholesterol values, cigarette smoking, and hypertension. The presence of two or more factors greatly increases the risk.

In Finland the serum cholesterol determinations have generally revealed mean values which in comparison with similar populations from other countries are remarkably high. Mean values of the magnitude of some 260 to 280 mg per 100 ml have been reported for certain population groups.

These high serum cholesterol values are probably chiefly dependent on the diet. The dietary intake of saturated fats (S) is very high and that of polyunsaturated fats (P) is low. The dietary P/S ratio is exceptionally low. It may also be possible that the population of Finland is genetically unusually susceptible to hyperlipidemia and hence also to CHD. However, the evidence to support such a view is meager.

Cigarette smoking, a further important risk factor, is quite common in the country, and the mean consumption of cigarettes is relatively high.

Hypertension also is prevalent in Finland. This may, at least partly, be due to the very high dietary intake of salt.

Thus a number of generally recognized risk factors for CHD occur in Finland in a markedly high degree. Whether they can wholly explain the unusually high mortality from CHD or whether additional yet unrecognized risk factors are also involved, is difficult to decide.

Paper presented at the Joint Congress of the International Association for Quality Research on Food Plants (CIQ) and the Deutsche Gesellschaft für Qualitätsforschung (Pflanzliche Nahrungsmittel) e. V. (DGQ) 12.–14th September, 1978 at Reading/ England.